Ankle Arthroplasty or Ankle Fusion?

What determines whether ankle replacement surgery or ankle fusion is better?

Currently, in the U.S., arthritis is the number one cause of disability, affecting more than 15 percent of the total population. As we age, we actually start looking for it in stiff finger joints and twinges in knee and hip joints. Joint replacement surgeries for knees and hips that have become damaged by arthritis have become so popular and successful that we almost consider them routine. 

There are over a hundred different types of arthritis, but it is osteoarthritis that is most often responsible for the wearing away of the cartilage in the joints. Most of the joints, that is. When it comes to the ankle joint, regular osteoarthritis or even rheumatoid arthritis may be the cause of the degeneration of the cartilage, but it is far more likely to be a specific form of osteoarthritis, post-traumatic arthritis. 

Post-traumatic arthritis is just what it sounds like; arthritis that is the result of some trauma or injury, usually one that has occurred years earlier. Sports injuries, falls and moving vehicle accidents often lead to this kind of trauma. The cartilage may be damaged at the time or the alignment of the bones may be slightly altered causing accelerated wear and tear. Additional stress on the ankle from body weight or repeated trauma will bring on the arthritis more quickly.  

Symptoms of Post-Traumatic Arthritis

How can you tell if you are developing post-traumatic arthritis in your ankle joint? Some of the most common symptoms include:

  • joint pain
  • swelling around the ankle
  • accumulation of fluid in the joint area
  • bone spurs creating a lumpy look around the joint
  • difficulty walking, running, climbing stairs and doing other activities without pain

Treatment Options for Ankle Arthritis

When the pain caused by arthritis in the ankle worsens and begins to affect daily activities or quality of life, your doctor will first suggest conservative treatment methods before any type of surgery is considered. These will include some combination of limiting impact-type activities, shoe modifications, cushioned inserts, bracing, anti-inflammatory medications, physical therapy and cortisone injections. If these do not prove to be successful, surgery may be recommended and will typically involve either ankle fusion or ankle arthroplasty.

Ankle Fusion or Ankle Arthroplasty

Ankle fusion, more technically, arthroscopic arthrodesis, is a procedure that seeks to decrease the pain of ankle arthritis and restore most, if not all, of the functioning ability of the ankle. It accomplishes this by removing all of the cartilage and fusing the bones together so that they can no longer rub against each other. The orthopedic surgeon may use plates, screws and even bone grafts for the fusion. 

An ankle fusion typically lasts a lifetime. Although some degree of motion may be less than what is normally found in a non-arthritic ankle, there was already decreased mobility before the procedure, due to the pain and damage of the arthritis. 

Ankle arthroplasty, with is ankle joint replacement surgery, involves the actual replacement of the ankle joint, much like what is commonly being done with knee and hip joint replacements. A plastic or metal prosthesis is used to replace the parts of the joint damaged by the arthritis. This procedure can restore a greater range of motion than a joint fusion, but the artificial parts are expected to need replacement at some point. 

Which procedure is right for you? This is a decision that can only be made in consultation with your physician, who will take into account the condition of your ankle, as well as your age, health and activity level goals.  

If you have questions about ankle pain or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC. To schedule an appointment, or if you just have questions, please use our convenient online contact form by clicking here.